A team approach to the complexities of advanced PC care.
As recently as five years ago, there were very few options available for patients with advanced, metastatic prostate cancer,” says Dr. Evan R. Goldfischer, co-CEO of Premier.
Today, however, the situation is much brighter. “A number of new drugs have been approved—with new mechanisms of action—that extend life, improve quality of life and control complications such as osteoporosis and osteopenia,” he says.
In direct response to these newly approved drugs, the American Urological Association updated its Advanced Cancer Guidelines in April, just 18 months after the previous update. “That indicates how quickly the field is changing,” Goldfischer says.
“There are so many new medicines in this space, understanding how to combine and sequence them is becoming a subspecialty in itself,” Goldfischer says
Therapeutic Developments
About 25 percent of newly diagnosed prostate cancers are con-sidered to be aggressive, but since the introduction of the PSA test, fewer than 4 percent of initial diagnoses are of metastatic cancer, says Dr. Naeem Rahman, director of the Prostate Cancer Clinic. Indeed, diagnostics plays a crucial role in determining when treatment is necessary and in achieving better outcomes with these cases.
“The newest test we have is sodium fluoride PET scanning, which is able to detect bony metastasis of prostate cancer,” he says. Another test, OncoType DX, helps tease out potentially lethal forms of the disease. “One of the challenges of PC is that some conventional wisdom says that all prostate cancers are slow-growing and not likely to be lethal. But that is not the case. This test screens for about 17 different genes that have been linked to high-risk cancers and gives the cancer a score based on these genotypes. The score helps us determine the appropriate treatment regimen. It has been a very valuable tool.
New treatment options include immunomodifying agents, such as Provenge, that enhance the patient’s immune response to attack the cancer. “We harvest the patient’s own dendritic cells (white blood cells), prime them outside the body and then infuse them back into the patient—much like a vaccine,” Dr. Rahman explains. “It is very well tolerated and doesn’t have many side effects.” Other medications, such as Zytiga, work to block the hormones that feed the cancer. Injections of Xofigo (radium 223), not only blocks hormones, they also kill cancer cells that have spread to the bones. These drugs have been shown to significantly improve survival rates.
The Team Approach
To keep up with the pace of developments, Premier Medical Group has reconfigured its Prostate Cancer Clinic to include a comprehensive, team-oriented approach to caring for patients with advanced disease.
“It requires a team to stay on top of all these new breakthroughs,” says Dr. Rahman. “It is important to have one physician dedicated to staying abreast of the new treatment algorithms and acting as the point person for implementing these treatments and ensuring that the entire team understands the process.”
“Patients with advanced disease now will have a unified home for their care, one where they can develop rapport with their team of caregivers. Any time you add continuity of care, you have better outcomes and higher patient satisfaction,” Dr. Rahman says.
“Another significant benefit of a dedicated clinic like ours is the ability to offer patients the opportunity to join clinical trials,” Dr. Rahman says. “We participate in multiple advanced trials involving immunotherapy and hormone receptor medication.”
As these and other new approaches are further developed, Dr. Goldfischer and Dr. Rahman and his team will remain at the forefront, so as to offer the best care possible to patients. “We are committed to staying current during this very exciting time in PC care,” Goldfischer says.